BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Tom Torlakson, Chairman
851 (Steinberg)
Hearing Date: 5/14/07 Amended: 5/2/07
Consultant: Nora Lynn Policy Vote: Health 7-3; Pub Saf
4-1
_________________________________________________________________
____
BILL SUMMARY:
SB 851 would create the Corrections Mental Health Act of 2007, a
comprehensive system of care for individuals with serious mental
illness (SMI) who are involved in the state's criminal justice
system. The bill would authorize superior courts to develop and
implement mental health courts, requiring those that do opt in
to establish a protocol to determine the eligibility of
defendants with SMI for participation and subsequent diversion.
SB 851 would also permit parolees to participate in mental
health courts, as specified, and require mental health care for
those incarcerated in state prisons, on parole or completing
parole. Several of the provisions of SB 851 pose state-mandated
local programs.
_________________________________________________________________
____
Fiscal Impact (in thousands)
Major Provisions 2007-08 2008-09 2009-10 Fund
Mental health courts, Unknown, potentially major costs,
Various*
diversion to services, potentially offset by reduced
recidivism
parole services, reports, and foregone incarceration in
the
training, mandate long term; see staff comments
CDCR: training Likely $7,000 range General
CDCR: multidisciplinaryLikely $20,000 annually,
potentiallyGeneral
parolee mental health offset by reduced recidivism
needs assessment, and foregone incarceration
housing, services in the long term; see staff comments
DMH: oversight of services Unknown, potentially major
costsGeneral
_____
* General, Trial Court Trust Fund (TCTF), Mental Health Services
Act (MHSA), Mentally Ill Offender Crime Reduction (MIOCR) grant,
Substance Abuse and Mental Health Services Administration
(SAMHSA) grant, and local funds
_________________________________________________________________
____
STAFF COMMENTS: This bill meets the criteria to be placed on the
Suspense file.
Courts
There are currently 39 mental health courts (MHCs) operating in
31 counties.
SB 851 does not require the creation of any additional MHCs; to
the extent courts elect
-1-
Page 2
SB 851 (Steinberg)
to create additional MHCs and divert SMI defendants to mental
health resources under SB 851 or modify existing MHCs to meet SB
851's standards, however, costs would be substantial.
A preliminary survey conducted by the Administrative Office of
the Courts (AOC) of several of the existing MHCs indicated that
their average annual operating costs are approximately $239,000
each, including personnel, overhead, program development and
training. The start-up costs for a new MHC is approximately
$23,000. In comparison to a standard court's operating costs,
the added annual cost of operating MHCs, taking into account
only justice court personnel, is approximately $108,000 per MHC.
Staff notes that if the MHCs surveyed by the AOC were found to
be comparable to the MHCs required in the bill, at that cost, if
the remaining 27 counties were each to establish a single MHC,
differential court costs would exceed $3 million.
This cost differential departs somewhat from that outlined in an
analysis of SB 851 prepared at Sen. Steinberg's request by the
Legislative Analyst's Office (LAO), which the Senator's staff
has provided to committee staff. Among other assumptions the LAO
estimated MHC per-court costs would likely be less than standard
courtroom costs based on an AOC analysis of drug courts that
found their average operational cost was somewhat lower than the
traditional criminal court process for offenders in Superior
Courts.
SB 851 would further allow CDCR to contract with superior courts
to use MHCs as mental health referral courts for parolees with
SMI who are in violation of their parole or receiving new terms.
Parolees are the responsibility of CDCR; while the bill allows
for a contracting process between MHCs and CDCR, it will require
considerable levels of dedicated staff time for collaboration
among the courts, CDCR and the Board of Parole Hearings to work
out the interrelation of the systems and the paroling
authorities in place. In addition, reporting requirements placed
on courts dealing with parolees (Sec. 1001.134 of the bill) may
drive additional information technology needs on the courts who
accept contracts with CDCR for parolee screening, and that could
in turn increase contracting costs.
Services
SB 851 would require MHCs to use community mental health
providers and other agencies to offer defendants access to
appropriate treatment services and establish a treatment plan
for each defendant based on a formal assessment of the
defendant's mental health and substance abuse treatment needs.
Funding for these services would be provided through the MHSA.
SB 851 amends the MHSA funding prioritization to add, after
existing programs and then programs in counties with high
incidence of homeless SMI, funding for counties to serve those
subject to arrest or hospitalization, discharged from hospital
or jail, or successfully completing parole. Staff notes
treatment services to prison inmates and parolees are not
eligible for funding through this program. Staff further notes
that there are protocols
Page 3
SB 851 (Steinberg)
required for use of MHSA funds involving review and approval by
DMH, stakeholders and the MHSA Oversight and Accountability
Commission that have to be satisfied prior to the use of these
funds.
Assuming for purposes of an estimate, as the LAO did in its
analysis, that SMI offenders would require at least the same
level of care as those classified in CDCR as needing Enhanced
Outpatient Program (EOP) or higher level of care, each
defendant's annual treatment services would cost in the $20,000
range annually. If 3,500 individuals were to be diverted from
standard criminal dockets via MHCs to services described in SB
851, annual treatment costs would be in the $70 million range
annually.
As counties opt in, staff notes the Department of Mental Health
(DMH) and county mental health programs' staff resources,
programs and services will be increasingly impacted.
Requirements for information sharing for data collection,
evaluation, development of standards and regulations are all
significant, and for counties that elect MHCs, there will
infrastructure and personnel impacts that will be potentially
substantial and challenging.
CDCR
The Mental Health Association of California estimates that from
15 percent to 20 percent of CDCR's 172,000 prisoners and 117,000
parolees are SMI. The department is currently operating under a
series of federal lawsuits and settlements, one of which
addresses its management of mentally ill inmates, which the LAO
describes as follows in its Analysis of the 2007-08 Budget Bill:
The Coleman case, filed in 1992, involves allegations
that the state prison system provided
constitutionally inadequate psychiatric care for
inmates. A federal court found the state to be in
violation of federal constitutional standards for
inmate medical care and established a special master
in 1995 to monitor state efforts to remedy the
problems. The state implemented a series of remedial
actions, which are still continuing.
SB 851 requires all parolees with SMI to receive comprehensive
mental health care and supportive services; requires CDCR to
"ensure" the mental health needs of all parolees are in
accordance with community standards of mental health care; and
requires CDCR to establish service standards in consultation
with DMH for mentally ill inmates with SMI that ensure, upon
release, to reach their potential as productive citizens.
CDCR projects it will require an additional 197 staff an at
annual cost of between $11 million and $14 million General Fund
to comply with these requirements. To the extent these programs
reduce recidivism and, therefore, there are foregone
incarceration costs in the long term, costs could be offset to
some degree.
Page 4
SB 851 (Steinberg)
SB 851 requires CDCR to provide training for all persons
responsible for management and care of persons with SMI in the
custody of the department and further requires it to ensure "all
correctional officers" are trained in dealing with inmates with
SMI. If 30,000 correctional peace officers were to need a
one-time four-hour training, costs to conduct the training,
including coverage using overtime to fill behind staff, would be
in excess of $7 million.
LAO
As previously discussed the LAO prepared a fiscal analysis of SB
851 at Sen. Steinberg's request.
The LAO analysis focused solely on the fiscal impact to state
criminal justice agencies, specifically courts and corrections,
and did not estimate the costs or savings accruing to other
state or local agencies or other societal impacts, though the
office acknowledged there would be such impacts. The LAO
analysis reflected full-year estimates of fiscal impacts that
would likely result after SB 851 had been fully implemented,
which would likely take at least a couple of years, and assumed
as previously mentioned that the SMI affected by SB 851 would be
those classified in CDCR as needing EOP or a higher level of
care. Finally, the LAO assumed a 15 percent recidivism rate
among MHC program participants, based on outcomes of mental
health and drug court programs in California and nationwide, and
that among the SMI parolees who participate in treatment under
systems of care, a 58 percent reduction in the number of
offenders who return to prison, based on outcomes for Sen.
Steinberg's AB 2034 (Chapter 518, 2000) and AB 34 (Chapter 617,
1999).
Based on these assumptions, the LAO estimates that costs for
mental health courts to divert offenders from prison could
generate net state savings of a couple of tens of millions of
dollars annually when fully implemented, with the actual savings
depending on the number of offenders who participate in MHCs,
the number diverted from prison by the courts, the rate at which
these offenders completed treatment and the rate at which the
offenders subject to the MHCs resumed criminal activity during
or after their receipt of treatment. The LAO estimates that
expanded mental health and other services for inmates and
parolees would result in net state costs of a few million
dollars annually, through the actual net fiscal impact each year
could range from savings of several millions of dollars to costs
of more than $10 million. It will likely cost the state a few
tens of millions of dollars annually to provide SMI offenders
with a broader array of services than they are likely to receive
now on parole, as well as to provide pre-release screening. The
LAO's analysis found these costs were likely to be mostly, but
not completely, offset by reductions in state prison operating
costs from lower recidivism among these offenders. Last, MHCs
for SMI parole violators would probably not result in either
significant net state costs or savings. The office estimated
that the provision of mental health treatment and other
services, like housing and employment services, would cost the
state as much as a couple of tens of millions of dollars
annually when fully implemented, but the estimated savings from
reduced prison population would be of a roughly similar
magnitude.